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Interventions Targeting Social and Vocational Dysfunction in Individuals with a Schizophrenia Spectrum Disorder

  • Cali F. BartholomeuszEmail author
  • Eóin Killackey
  • Andrew Thompson
  • Stephen J. Wood
Chapter

Abstract

Individuals with a schizophrenia spectrum disorder are among the most marginalized of any chronic illness group, having poorer performance and outcomes in nearly every domain of health and functioning. Poor social functioning is now widely acknowledged to be a major indicator of the prognosis of schizophrenia as well as a major contributor to illness outcome. Social and functional disabilities have serious detrimental effects on the individuals’ quality of life and recovery, yet up until the twenty-first century treatment had largely been concentrated around symptomatic improvement, with the assumption that functional recovery would automatically follow. However, statistics on functional outcomes for individuals with schizophrenia and other psychotic illnesses suggest that this is in fact a relatively rare phenomenon. The definitions of “functioning” and “outcome” have also been poorly defined and inconsistent over the years, with alleviation of psychotic symptoms and decreased hospital admissions weighing heavily in the characterisation of improved functional outcome. In the last decade most studies have included a general measure of global functioning and/or education/employment as an indicator, but these performance measures have generally not been the primary topic of interest. Only recently has the incorporation of “social” functioning (i.e. social competence, independent living, community involvement and interpersonal relationships), been included as an important factor in overall outcome and moved into the spotlight as a major target for intervention. Historically, social skills training and cognitive remediation have been used to target deficits in social behaviour and cognition, respectively. However, new intervention strategies are being designed to target the underlying thinking patterns related to social interaction, termed social cognition. This chapter will review the different types of interventions that have been or are currently used to treat social and occupational dysfunction in schizophrenia spectrum illnesses, and assess their effectiveness in terms of the immediate and longitudinal outcome.

Keywords

Illness outcome Functional disability Social functioning Vocational intervention Social cognition training Early intervention 

Abbreviations

ACC

Anterior cingulate cortex

CAT

Cognitive adaptation training

CBT

Cognitive behavioural therapy

CET

Cognitive enhancement therapy

CGI-CogS

Clinical global impression of cognition in schizophrenia

CRT

Cognitive remediation training

EMT

Emotion management training

EQ

Emotional intelligence/emotional quotient

EST

Enriched supportive therapy

FEP

First episode psychosis

GAF

Global assessment of functioning

HoNOS

Health of the nation outcome scale

ICCD

International Center for Clubhouse Development

IPS

Individual placement and support

MATRICS

Measurement and treatment research to improve cognition in schizophrenia

MCT

Metacognitive skills training

METT

Ekman’s micro-expression training tool

mPFC

Medial prefrontal cortex

MRI

Magnetic resonance imaging

NET

Neurocognitive enhancement therapy

NIMH

National Institute of Mental Health

PA

Picture arrangement

PACT

Program of assertive community treatment

POFA

Pictures of facial affect

QLS

Heinrichs-Carpenter quality of life scale

RCTs

Randomised controlled trials

SBS

Social behaviour schedule

SCET

Social cognition enhancement training

SCIT

Social cognition and interaction training

SF-36

36 item short-form health survey

SOFAS

Social and occupational functioning assessment scale

SOHO

Schizophrenia outpatients health outcomes

SSOS

Scottish schizophrenia outcomes study

SST

Social skills training

STS

Superior temporal sulcus

TAR

Training of affect recognition

TAU

Treatment as usual

ToM

Theory of mind

UCSD

University of California at San Diego

UHR

Ultra high-risk for psychosis

UPSA

UCSD performance-based skills assessment

WT

Work therapy

Notes

Acknowledgements

We would like to acknowledge the National Health and Medical Research Council of Australia for fellowship funding awarded to Dr Bartholomeusz.

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Cali F. Bartholomeusz
    • 1
    Email author
  • Eóin Killackey
    • 2
  • Andrew Thompson
    • 3
  • Stephen J. Wood
    • 4
    • 5
  1. 1.Department of PsychiatryMelbourne Neuropsychiatry Centre, The University of MelbourneMelbourneAustralia
  2. 2.Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of MelbourneMelbourneAustralia
  3. 3.Orygen Youth Health, Melbourne Health, North Western Mental HealthMelbourneAustralia
  4. 4.University of BirminghamBirminghamUK
  5. 5.Department of PsychiatryMelbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne HealthMelbourneAustralia

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